Assessment and Scoring - Part 1 Flashcards
Who is part of the CAPD evaluation team?
Audiologist (manages and coordinates evaluation; top dog)
SLP (assesses receptive and expressive language skills, phonological skills, and written language abilities)
Psychologist (assesses cognitive skills and capacity for learning)
Social worker (serves as a liaison between home and school)
Parents (provide prenatal and neonatal history; information regarding developmental milestones, auditory behavior, and medical and academic history)
Physician (rules out a medical pathology that may affect learning abilities)
What is a test battery?
A number of tests used to diagnose a certain condition
Why is a test battery used for CAPD testing?
CAPD is not a unitary disorder (varying clinical presentations)
Different measures are required for accurate assessment of central auditory processes
Multiple assessment measures also may help establish a more appropriate management of (C)APD
What questions should be asked of the test battery to ensure it is accurate and useful?
Does the battery improve sensitivity and specificity over using individual tests?
How many tests are needed to obtain optimal sensitivity/specificity? (at some point, adding more tests may be detrimental to an accurate diagnosis)
Two to four tests in a test battery can provide maximum sensitivity (testing different areas thought to be a problem)
What criteria should be used to determine whether a patient passes or fails?
Lax criterion will yield better sensitivity but poorer specificity (won’t miss anyone but probably over-diagnosing)
Intermediate criterion
Strict criterion will yield better specificity but poorer sensitivity
*Problem is we don’t have one recommended one
What is the reason behind a lax criterion trend?
As size of the test battery increases, greater probability that a patient will fail any single test
It improves sensitivity but can undermine specificity as normal patients have an increased chance of being incorrectly identified
*only need to fail one test
What is the reason behind the strict criterion trend?
As size of the test battery increases, less probability that a patient will fail all tests
Beneficial for detecting normal function and improves specificity but can undermine sensitivity as patients with abnormal function will be less likely to fail the entire battery when more tests are included
For example, a patient is more likely to fail all tests when a battery has 2 to 3 tests as compared to when it has 10 tests
What is the reason behind the intermediate criterion?
Most reliable criteria
Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)
Are tests with relatively low sensitivity/specificity useful diagnostic indicators of CAPD?
No
Should CAPD tests demonstrate test-retest reliability and age-appropriate norms?
Yes
Should tests that require extensive training, time, and client practice appropriate for clinical settings?
No
What are symptoms specific considerations?
The test battery process should not be test driven; rather, it should be motivated by the referring complaint and the relevant information available to the audiologist
We should not just do the same exact tests that we are most comfortable with
Should audiologists be sensitive to attributes of the individual?
Yes
The attributes may include language development; motivational level; fatigability; attention and other cognitive factors; the influence of mental age; cultural influences; native language; and socioeconomic factors
Does the patient’s history indicate they have the developmental maturity to complete the auditory task? (can they complete the tests)
Can individuals who are medicated for attention, anxiety, or other disorder be tested when on medication?
Yes
But there is still a caveat (you decide if you can test them or not)
Screening test for attention can be done if unsure
What age should you diagnose CAPD?
Only 7 years and above
Attention, memory, language, and several other aspects should be developed for assessment
What is the pediatric speech intelligibility test (PSI)?
Screening for CAPD (not diagnostic)
Authors: Jerger and Jerger
Low-redundancy speech test (words or sentences)
3-6 years old
Moderate to high sensitivity
Assesses auditory figure ground and auditory closure
Linguistic loading (language in the test)
Sensitive to lower brainstem deficits and CAPD (distinguishes between children with central auditory lesions and those without)
Insensitive to the normal developmental difference between cognitive skills
What is the PSI comprised of?
20 monosyllabic words
Message to competition ratio (MCR) (like SNR) - standard MCR is 4 dB MCR
Competitors/maskers can be sentences (either in the same ear or a different ear)
What is format I for PSI?
Receptive language level I
Age range: 3-4 years
“show me” carrier phrase
What is format II for PSI?
Receptive language level II
Age range: 5-6
“The bear is brushing his teeth” no carrier phrase
What are the results for the PSI based on?
Five items for performance on ceiling and floor of the test
First trial of a test condition = 80 to 100% (> 4/5) - ceiling
First trial of a test condition = 0 to 20% (< 1/5) - floor
If first trial results in a ceiling or floor level, only one trial (five items) are presented
If performance is at the midrange level, i.e., = 21 to 79%
Ten items presented (second trial of five words is presented)
What is ICM and CCM?
ICM (ipsi) - both the competing noise and the stimuli presented in the same ear
CCM (contra) - competing noise and stimuli in different ears
What are the guidelines for interpretation of abnormal PSI results?
ICM (0 dB MCR) - less than 80%
CCN (-20 dB MCR) - less than 70% (RLL I) and less than 90% (RLL II)
Why is it recommended that the northwestern syntax screening test (NSST) be administered prior to the PSI?
Maturational change characterizes language performance
The goal of the PSI was to provide a good auditory test of processing that was not influenced by the child’s language abilities
An audiologist cannot accurately gauge a child’s true language abilities to decide whether to administer Format I or II cards
Based on statistical analysis, receptive language ability provided the best variation in sentence intelligibility of children between 3 to 6 years
What is the ACPT?
Screening test
Developed by Keith (1994)
Binaural test
6-11.11 years
Developed as a screening test for ADHD, not CAPD
Measures a child’s selective attention as indicated by correct responses to specific language cues and sustained attention as indicated by the child’s ability to attend on a task for a prolonged time
Practice test should be administered prior to the actual test to make sure they understand
What does the ACPT consist of?
Word identification of the word dog in a series of familiar monosyllabic words that do not tax a child’s linguistic and cognitive abilities
Example: toy, face, teach
Total of 20 monosyllabic words are repeated and rearranged to form a 96-word list presented 6 times (576 words)
15 minutes test time
Performance at the beginning of the test (list 1) is compared to the performance at the end of the test (list 6) to provide an indicator of auditory vigilance
What constitutes a failing score for the ACPT?
Criterion (failing) scores provided for each age group indicate if the scores match those of children with ADHD
What is the presentation level for the ACPT?
Binaurally under headphones (or inserts) at the MCL (~50 to 60 dB HL) of the listener
Test was normed for headphones so if performed in the sound field the results should be interpreted with caution
This test was normed for listeners with normal hearing
What is the test sensitivity for ACPT?
High hit rate
Hit rate (sensitivity) ~70%
Miss rate ranges from 18 to 29% (misses existing ADHD)
What are the two types of errors that are possible on the ACPT?
Inattention error - not responding to the word dog
Impulsivity error - responding to a word other than dog
What is ACPT used for?
To differentially diagnose children with ADHD from those with CAPD
It can be combined with visual vigilance tests to differentially diagnose ADHD (since children with ADHD will do poorly on visual vigilance tests too)
What is the criterion score for ACPT for age 6?
38 or more
What is the criterion score for ACPT for age 7?
32 or more
What is the criterion score for ACPT for age 8?
25 or more
What is the criterion score for ACPT for age 9?
19 or more
What is the criterion score for ACPT for age 10-11?
16 or more
What are prevalence score for ACPT?
The less the difference between presentation 1 & 6 the higher the percentage of the sample of participants NOT diagnosed with ADHD
Fewer differences = not diagnosed with ADHD
What is the SCAN-3 C?
Screening test for CAPD
Author is Keith (2009)
SCAN-3: C is the older SCAN-C test reconfigured as a battery of tests
SCAN = screener for central auditory nervous system
3 parts - one screener, one diagnostic, and one supplemental
10-15 minutes for the screening
20-30 minutes for the diagnostic and supplementary tests
What is the purpose of the SCAN-3 C?
Designed to identify auditory processing disorders in children in the areas of temporal processing, listening in noise, dichotic listening, and listening to degraded speech
What population can take the SCAN-3 C?
Ages 5 to 12.11 years old (12 years 11 months)
Children should have passed screening at 1000, 2000 & 4000 Hz bilaterally (pure tones); no ME issues as identified by tympanometry is desirable
What level do you present through the audiometer for the SCAN-3?
50 dB HL for all SCAN-3 (children & adults) tests and sub-tests
Audiometric set up for all SCAN-3 binaural tests:
Ext. B = Right ear
Ext. A = Left ear
What presentation level should the SCAN-3 be administered with a CD player?
Can be administered by school personnel and others through a CD player (no audiometer) in a quiet area at the listener’s MCL
If listener’s MCL cannot be obtained, the tests are to be administered at the clinicians MCL
MCL was found to vary significantly between and within individuals
Are test scores and interpretations on the SCAN-3 affected by variability of the MCL presentation?
Yes
The biggest MCL effect was noted on the performance of the auditory figure ground, monaural low redundancy, and binaural integration types of auditory processing tasks
What are the recommendations for the presentation levels for the SCAN-3?
SCAN-3 users administer the test through an audiometer at 50 dB HL
Further, if audiologists received SCAN-3 test results administered by other professionals, it would be important to know under what conditions/presentation level testing was performed to determine the validity of the results
What are the three screening tests in the SCAN-3 C?
Gap Detection [GD] (only for children 8 through 12 years)
Auditory Figure Ground +8 dB [AFG8] (used as both screener and diagnostic)
Competing Words–Free Recall [CWFR]*
What are the 4 diagnostic tests for SCAN-3 C?
Auditory Figure Ground +8 dB [AFG8]# (do not do if done in screener)
Filtered Words [FW]
Competing Words–Directed Ear [CWDE] (repeat the words you hear in the right ear; engaging more attention)
Competing Sentences [CS] (kind of like PSI)
What are the 4 supplementary tests for the SCAN-3 C?
Competing Words–Free Recall [CWFR]* (do not do if done in screener)
Auditory Figure Ground 0 dB [AFG0] (harder than +8)
Auditory Figure Ground +12 dB [AFG+12] (easier than +12; could suggest improvement with FM system)
Time Compressed Sentences [TCS]) - speech is faster; puts stress on the system
What is free recall?
You hear the word, you say it
Not telling them which ear to listen to
What are filtered words?
Filter out some frequencies of a word
Can still tell what the word is due to auditory closure
What are the specifics of the gap detection test in the SCAN-3 C?
Age range: 8-12.11
Screens disorders of timing within the auditory system (such as temporal processing disorders)
Presents two tones separated by a gap ranging from 0 to 40 ms
Ask if one or two tones is heard (gap detection threshold is the smallest interval where a listener consistently identifies 2 stimuli)
What are the tracks of the gap detection test on the CD?
Practice test is track 3 (if the child cannot respond to the practice attempts after repeated attempts do NOT administer this test)
Test items are track 4
What are the specifics of the auditory figure ground +8 dB test?
Tracks 5 to 9
Speaker’s voice is at +8 dB (+8 SNR) more intense than background noise
“Say the word…” with multi-talker speech in the background
Test presented monaurally to each ear
What is the track for the practice items for the auditory figure ground +8 dB test?
Track 6
Two practice items presented to the right ear
If the child responds correctly proceed to test items
If the child responds incorrectly to one practice item, pause CD and reinstruct
No additional directions before practice items played to left ear
If child responds incorrectly to one or both practice items (track 8) for the left ear, still proceed with test
Once test begins, do not pause CD or replay test items
What are the specifics for the free recall test?
Tracks 10-12
Dichotic listening task that assesses auditory maturation or developmental delay
Two practiced items and 20 test items
The child hears two words simultaneously in each ear and has to repeat back both words
No direction to listen to right or left ear – free recall
Free recall removes the variable of attention from the task
If child responds incorrectly to practice items, pause the CD, reinstruct, and replay practice items
Once the test begins, do not pause the CD
Circle + for each correct response
Circle – for each incorrect response; no response; “I don’t know”
Record incorrect responses
Practice items are not scored
Why should we record incorrect responses (write the word that they said that was wrong)?
To see what kind of errors they are making
Do they have to do the diagnostic tests if they pass all of the screening tests?
No
If the child is younger, they only need to pass two of the three tests to pass (cannot do gap detection test on a child that is younger than 8 years)
What is a scaled score?
A scaled score is the result of some transformation(s) applied to the raw score
To report scores for examinees on a consistent scale
Compared to peers
Typically used for sub-tests
Sensitivity is 78% if the cut off is a scaled score of < 8
Specificity is 88% if the cut off is a scaled score of < 3
*fair sensitivity and specificity
Should a child with typical gap detection abilities be able to detect a gap of 20 ms?
Yes
A child who fails the gap detection test should be further evaluated for possible temporal processing disorders
How should a child be evaluated if they fail the AF +8?
Should be assessed further for speech in noise listening needs
How should a child be evaluated if they fail CW-FR?
Should be referred for further assessment
Dichotic test provide information about maturation of auditory neurological pathways
Two other dichotic test from the SCAN-3: C maybe performed
What is the filtered word tests?
Test used to assess auditory closure skills
Low pass filtering at 750 Hz (parts of the auditory signal in the stimulus word at frequencies >750 Hz are filtered out requiring the child to fill in)
Determines auditory processing abilities in poor listening environments
Monaural test (each ear done individually)
Two practice items for right and left ear (present right first)
Practice items can be repeated once
Proceed to test items even if practice items are missed for the left ear
What is the competing words-directed ear test?
Dichotic listening task is used to assess development and maturation of the auditory system
Two words are heard simultaneously; one in each ear
The child is instructed to repeat both words; repeating the word presented to the right ear first
After completed the right-ear directed items, child is then instructed to repeat the left-ear directed items
Responses must be repeated correctly for each directed ear
Have them point to the right and left ear before started test to ensure they know right and left
Replay practice items once if needed
What is the competing sentences test?
Used to assess development and maturation of the auditory system and hemispheric specialization
Dichotic test with sentences presented to both ears simultaneously
The child is instructed to only repeat back sentences from the right ear for test items 1-10 and only sentences from the left ear for test items 11-20
Younger children may have difficulty repeating back only the sentences from one ear (but don’t stop the test)
Ask them to point to right and left ear
Need to get bolded words right
When would you administer the AFG +12 test?
May administer this test if child does not pass the AFG +8
Monaural test; each ear tested individually
Supplementary test
When would you consider doing the AFG +0 test?
May administer this test if more information is needed for a child’s ability to listen in noise
Monaural test; each ear tested individually
Supplementary test
What is the time compressed test?
Designed to assess a child’s ability to process speech presented at a rapid rate
Monaural test, each ear tested separately
Five practice items recorded at a normal rate to make sure that child can repeat the length of the sentence
Model the practice items if child repeats them incorrectly or at a faster than normal rate
Practice items can be replayed once
If the child cannot repeat the practice items, do not proceed with the test
No practice items for the left ear
According to SCAN-3 C, what is considered a meaningful interpretation of auditory processing abilities?
A careful interpretation the test battery scores
Consideration of the pattern of the test scores
Consideration of other factors including
What is ear advantage?
Used in scoring
It is the mathematical difference between the right ear and left ear raw scores
A positive value indicates a right ear advantage and a negative value indicates a left ear advantage
Powerful indicators of a possible hemispheric dominance for language and neurologically-based language learning disorders (the more extreme the advantage, the greater possibility of an auditory-based language or learning disorder)
Is a significant LEA considered abnormal?
Yes
It may indicate poor localization of hemispheric function related to a language disorder
What tests do you score on the SCAN-3 C?
All tests except the screening tests (wouldn’t move on to the diagnostic tests if they passed the screening)
Will children with typically developing auditory systems have a higher RE score for all dichotic listening tests on the SCAN-3 C?
Yes
Such as competing words – directed ear, competing words – free recall, and competing sentences
Will children with a typically developing auditory system have similar RE and LE scores on all the monaural degraded tests on the SCAN-3 C?
Yes
Such as auditory figure ground, filtered words, and time-compressed sentences
As the child grows older, does the REA diminish and the LEA improves?
Yes
Occurs as the corpus callosum matures
The REA is minimal often by early adolescence (~12 years) and typically disappears by late adolescence (~18 years)
What results in a meaningful interpretation of auditory processing abilities?
A careful interpretation the test battery scores
Consideration of the pattern of the test scores
Consideration of other factors including information from parents/caregivers, behavioral observations of the clinician during the test, the child’s medical history, and the child’s academic performance
What are scale scored?
Scaled scores are normative scores specifically used to compare a child’s performance to their same-age peers
These scores are derived from the test raw score that are converted to a score metric with a mean of 10 and SD of 3
The range is 1 to 19
A scaled score of 10 corresponds to an average performance within the given age-group
Scaled scores of 7 and 13 are 1 SD below and above the mean, respectively
Where do you convert raw test scores to scaled scores?
Appendix C
What is the auditory processing composite score?
Provides information in the areas of degraded speech, listening in noise, and dichotic listening
Derived from summing the scaled scores of AFG +8, Filtered words, CW-Directed Ear, and Competing Sentences
Then converting the sum to a composite score using the table in Appendix D
Composite score is based on a metric with a mean of 100 and a SD of 15
Range is 40 to 160
Score of 100 is average of any given group
What are confidence intervals?
Confidence intervals allows you to determine with 90% or 95% probability or confidence that a certain range of scores contain a hypothetical “true” score within that range (every test has some degree of error)
Can only span the possible range for test scaled scores (1 to 19)
The critical value for building a CI is 2 (cannot have a CI if they score a 1, they would not have a range below their score)
The CI for the APC score can extend beyond possible range of 160
What are percentile ranks?
Provides age-based percentile ranks for scaled and composite scores to indicate a child’s performance to other children of the same age
What is descriptive classification?
Childs current auditory processing skills
Correspond to a deviation form a mean of 100
Help communicate the information better rather than discussing less easily understood descriptors
Is SCAN-3 C an improvement from other SCAN tests?
Yes
But some still think it shouldn’t be used for diagnostic purposes
What is the SCAN-3 A?
For adolescents and adults
CAPD assessment
Ages 13 to 50:11 years
Sub tests are the same as SCAN-3 C
Pass criterion is stricter for all tests
Screener takes 10 to 15 minutes to complete
Diagnostic assessment takes 30 to 45 minutes to complete
What is a clinical decision analysis (CDA)?
Statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
Measures include sensitivity and specificity, ROC curves, and factor analysis (reducing a large number of variables into a fewer number of factors)
What is a gold standard?
A single best test (or combination of tests) considered the current preferred method of diagnosing a particular disease
No gold standard test for CAPD, only gold standard group
What is the gold standard group for CAPD assessment?
Known to have the disorder
Typically patients with confirmed neurologic lesions of the CNS
Control group includes individuals without the lesions
What are the three commonly used test domains that exist for CAPD that should be measured using behavioral tests?
Auditory pattern/temporal ordering (APTO) tests - could be done using gap detection test
Monaural separation closure (MSC) - are you able to close the separation
Binaural integration/binaural separation (BIBS) - integrate and separate information between ears
What is the multiple auditory processing assessment test battery?
Developed as an effort to develop a quas-behavioral gold standard for CAPD
This work involved a series of studies and factor analysis to design careful test strategies
One test from each of the above domains (auditory pattern/temporal ordering, monaural separation closure, and binaural integration) was recommended for inclusion in a test battery, which increased the sensitivity of the test battery vs. using any one test by itself
What does a recommended CAPD evaluation look like?
Case history
Pre-test standardized questionnaires
CHAPS; SIFTER; Fisher, etc.
Behavioral measures
Pure-tone audiometry
Speech audiometry
(C)APD behavioral tests in the four important auditory processing areas
Other tests as needed such as attention or speech-in-noise tests
Electophysiologic measures
Immittance audiometry (including acoustic reflex thresholds)
Otoacoustic emissions (TEOAEs or DPOAEs)
ABR, mid- and late-latency auditory evoked responses
Psychoeducational evaluation
Speech and language evaluation
What are things to ask during case history?
Prenatal and postnatal
Developmental
Medical
Academic (failed grades, current academic performance, areas of strength/weakness, special education services)
Family (genetic, medical, first-degree relatives with developmental disorders)
Social (shy, aggressive, friendly, etc., plays/interacts comfortably with peers; prefers younger children/adults)
Results of other evaluations (psychoeducational; speech and language evaluation)
Work history; if patient is an adult
Do screening tests have advantages over diagnostic tests?
Yes
They place fewer demands on the healthcare system
Are more accessible
Less invasive and less dangerous
Less expensive
Less time-consuming
Less physically and psychologically uncomfortable for patients
*however, often imperfect and sometimes ambiguous (important to determine the extent to which these tests are able to identify the likely presence of CAPD)
What is the children’s auditory performance scale (CHAPS)?
Screening (questionnaire)
7 years old and older
36 item checklist divided into 6 listening conditions and functions
Each item scored on a 7-point scale
Used by parents and teachers
Evaluates listening behaviors in diverse listening situations, assesses child’s ability in comparison to peers, used as part of the screening process to identify children experiencing listening difficulties because of hearing loss and CAPD
What is the screening instrument for targeting educational risk (SIFTER)?
First through fifth grade
Ideally completed by teacher
15 questions (three in each 5 categorial areas)
Areas: academics, attention, communication, class participation, and social behavior
Educationally screening students with known or suspected hearing loss
Classroom teacher compares child’s functional ability to peers
Can be used to track child’s performance over time
What is fishers auditory problem checklist?
Provides good information on children’s functional listening abilities in the classroom (more restricted in scope than CHAPS)
Completed by teachers
Itemizes behaviors such as failure to attend to instructions, need for repeated instructions, easy distraction by auditory stimuli, degrading processing in a competing acoustic environment, also addresses attention and memory issues, several questions related to language-based deficits such as discrimination ability
Contains 25 items, each with a value of 4%
The observer is instructed to place a checkmark next to each item that is consistent with the exhibited behavior of the child
Items not selected by the observer are multiplied by 4 to determine a total percentage
What is the unpublished cutoff for the fisher?
72%
Children who scores at or below this should be referred for a full diagnostic test
Is the fisher often criticized?
Yes
It covers a broad range of characteristics by only a small number of items related to listening
Neither does it take into account listening behaviors of children with (C)APD depending on different listening environments
Should CHAPS, SIFTER, and TAPS-R be used to determine whether a diagnostic CAPD assessment is warranted?
No, should be used to highlight concerns about a child
Found that there is poor reliability between these screening tests to predict the individual test results and the overall risk for CAPD
Should a screening assessment of short-term and working memory be completed during a diagnostic assessment for CAPD?
Yes
Offered by TAPS-R
Two groups of skills are at least weaking correlated
Significant deficits in short-term/working memory could influence performance on tests for (C)APD
Are questionnaires not very good predictors?
Yes
The screening tests (like the ones in the SCAN-3C are better predictors of the diagnosis of CAPD)
Reduced costs, reduced over-referrals, time savings, and increased efficiency of identification and intervention will result from just doing the screening
What are electrophysiologic tests?
OAEs
Immittance audiometry
ABR (early-latency response)
Mid-latency auditory evoked response
Late-latency auditory evoked response
Why can you use electrophysiologic tests for CAPD?
Auditory evoked responses measure neuromaturation and neuroplasticity of the central auditory pathways
Electrophysiologic tests provide additional information about integrity of the CNS
This information may be important for purposes of differential diagnosis and site-of-lesion for some children
*useful for ruling out other disorders, not necessarily for diagnosing CAPD
Is the validity of speech-based CAPD tests problematic?
Yes
Speech-based tests are sensitive to phonological and linguistic impairments, which makes it difficult to disentangle auditory from other impairments
Not just based on perceptual processing, but also phonological processing (difficult for non-native speakers)
Memory and attention can also impact these tests
Verbal test responses may be affected by expressive skills
What are dichotic processing tests?
Different speech stimuli presented to each ear simultaneously
May assess either binaural integration or binaural separation
Sensitive to lesions of the CC and cerebral cortex
What are the temporal processing and pattern tests?
Monotic presentation to assess each ear independently
Often tones rather than speech
Assesses pattern perception and temporal functioning abilities
More sensitive to a compromised right hemisphere (if test requires a verbal response, it is then sensitive to left hemisphere lesions)
What are binaural interaction/fusion tests?
Binaural tests (either the same ear or different)
The information is presented in either a non-simultaneous, sequential manner or only a portion of the message is presented to each ear
These tests assess integration between two ears
Takes place at the auditory brainstem
What are monaural low redundancy speech/auditory closure tests?
Speech is redundant
Involves modification of the acoustic signal to reduce the amount of redundancy
Degraded speech by modifying frequency, temporal, or intensity characteristics
Moderately sensitive to cortical lesions (not brainstem)
